Medical Billing Specialist

5 days ago

Duluth, Minnesota, United States Pandya Medical Center Full time
Job Summary

The Medical Billing Specialist at Pandya Medical Center is responsible for ensuring accurate and complete coding information is collected and reported to private insurance and Medicare to complete the revenue cycle. This involves scrubbing encounters for accurate coding prior to claim creation, allocating correct modifiers and ICD-10 diagnosis codes to each CPT code, and ensuring timely claim submissions and follow-up on claim denials.

Key Responsibilities
  • Accurate and timely submission of medical claims to insurance companies and other payers
  • Review and analyze medical records to ensure appropriate coding of diagnoses and procedures
  • Document for providers and management any insufficient or unclear information on claims
  • Assign or reassign CPT, HCPCS, and ICD-10-CM codes as needed
  • Follow up on unpaid claims and initiate appeals for denied claims within 30 days of submission
  • Track the progress of claims through the clearinghouse and promptly address any issues
  • Resolve patient billing issues and questions via phone and email in a timely fashion
  • Stay updated on healthcare regulations, medical terminology, and coding practices
  • Follow HIPAA guidelines when accessing and sharing patient information
Requirements
  • Minimum of 3 years' experience with medical billing or revenue cycle in a medical setting
  • Certified Professional Coder thru AAPC or a Certified Coding Specialist thru AHIMA - Required
  • Knowledge of insurance guidelines including HMO/PPO, Medicare and other payers' requirements and systems
  • Knowledge of CPT, ICD-10, HCPCS Coding and utilization of modifiers
  • Knowledge of medical billing rules, modifiers, and strong understanding of EOBs and ERAs
  • Competent in computer skills, Microsoft Office or similar software
  • Experience with AthenaHealth, EHR is preferred or other similar EHR systems such as Epic, or eClinicalWorks
  • Experience with Family Practice and Primary Care outpatient billing (Preferred)
  • Exceptional Customer Service skills for interacting with patients regarding medical claims and payments
  • Self-motivated with ability to multi-task, prioritize work in a fast-paced, team environment
  • Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
  • Strong understanding of patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Benefits
  • Aetna Health insurance
  • Aetna Dental and Vision plans
  • Aflac Supplemental insurance plans
  • 401K match plan with up to 4% by Pandya Medical Center
  • Paid Time Off

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